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A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.
When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.
Summary: This SPA amends the State Plan to allow the State to enter into value-based contract arrangements with drug manufacturers through supplemental rebate agreements.
Summary: This SPA updates language on the Delaware excluded drug coverage pages to reflect coverage of selective medications by referencing the state’s webpage and policy handbook resources instead of listing specific covered medications. Additionally, the SPA amends the Title XIX Medicaid State Plan regarding physician administered drug reimbursement rates.
Summary: CMS is approving DE-19-0009 which amends the State Plan to allow Medicaid beneficiaries to request coverage from pharmacies of select FDA approved over-the-counter medications through an agreement with the Department of Public Health Medical Director for the purpose of generating a prescription and clarifies the coverage policy related to drugs indicated for the treatment of obesity.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend all copayments and premiums for all beneficiaries, modify telehealth benefits and allow payment accordingly, adjust the day supply or quantity limit for covered outpatient drugs, expand Prior authorization for medications automatic renewal without clinical review, or time/quantity extensions, and make exceptions to their published Preferred Drug List if drug shortages occur.
Summary: Revises the State Plan regarding the Pharmaceutical Services, specifically to require entities that purchase 340B drug products to request to use these drugs for all Department of Medical Assistance Program (DMA) patients, including Medicaid fee-for-service patients and for patients whose care is covered by Medicaid Managed Care Organizations.
Summary: Revises the Multi-State Purchasing Pool Supplemental Rebate Agreement (SRA) for Pharmaceutical Products to Include Medicaid Managed Care Organization (MCO) Utilization for the Accrual of Supplemental Rebates.
Summary: This SPA implements a new drug pricing methodology to reimburse pharmacies using National Average Drug Acquisition Cost files for pharmacies that dispense pharmaceutical products to Medicaid recipients.
